1134340250 NPI number — OMNI FAMILY HEALTH

Table of content: (NPI 1134340250)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134340250 NPI number — OMNI FAMILY HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OMNI FAMILY HEALTH
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134340250
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/09/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4900 CALIFORNIA AVENUE
Provider Second Line Business Mailing Address:
400B
Provider Business Mailing Address City Name:
BAKERSFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93309-7081
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-459-1900
Provider Business Mailing Address Fax Number:
661-459-1974

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1215 JEFFERSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DELANO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93215-2203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-459-1900
Provider Business Practice Location Address Fax Number:
661-459-1974
Provider Enumeration Date:
05/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CASTILLON
Authorized Official First Name:
FRANCISCO
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
661-630-7050

Provider Taxonomy Codes

  • Taxonomy code: 261QC1500X , with the licence number:  120000654 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: FHC70972F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: HAP70972F . This is a "FAMILY PACT" identifier . This identifiers is of the category "OTHER".
  • Identifier: ZZZ03011Z . This is a "MEDICARE PART B" identifier . This identifiers is of the category "OTHER".
  • Identifier: PHA322610 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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